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003899 (SFD)i P.O. BOX 1504 1110. 003899 Buildingt 78-105 CALLE ESTADO Address 30-163 Vista Orande . LA QUINTA, CALIFORNIA 92253 Owner etro ' Homes BUILDING: TYPE CONST. OCC: GRP. Mailing. Address 79-811 Country Club Drive _ _ _ � . A.P. Number , City Zip Tel.. Be=uda QJ i. .' 9a2 }I . _x.95-; f.225 _ Legal Description Contractor . - . Sil3 le -ftmil. 3�e� lkfi Man HdWard . Project Description ' Address r Sam City Zip Tel State Lic. City & Classif. 476007 Lic. # Sq. Ft. 1900 No. No. Dw. ..Arch., Engr.; .... - _. . Size Stories Units Designer New -0. Add ❑ Alter ❑ Repair ❑ Demolition ❑. Address Tel. Gtr ase 6251 City Zip State �� .. LICENSED CONTRACTOR'S DECLARATION . I hereby'affirm that I,am licensed under provisions of Chapter 9 (commencing with Section 7000) ofiDivision 3,of=the Business and,Proffessions Code, and my license -is in full force and ' effect.. DATE - OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following $99 . S47 reason: (Sea. 7031.5,Business and Professions Coder Any city or. county which requires a .7 permit: to construct, after, improve, demolish, or repair any structure, prior& to its issuance also' *k ' requires the applicant for such permit to file a signed statement that he is licensed pursuant to - PERMIT - - -AMOUNT the provisions of the Contractor's License Law, . Chapter 9 (commencing with Section 7000) of ' DiW§Ion 3 of the Business and "Professions Code, or that. he .is exempt therefrom,and the basis- I for the. alleged exemption. Any violation of Section 7031.5 by 'any applicant for a. permit Plan Ch. k.S 9111 _ Oaf% - - subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - - _ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.-Bal. A 1117_ Ci do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and. Const'. 4 Professions Code: The Contractor's License Law does not -apply to an owner of property who. - Al l •_ 1 . • buildsorimproves thereon and who does such work himself -or through his own employees, Mech provided. that' such improvements are not intended or offered for sale. If, -however, , , the building or improvement is sold within one year of completion, the owner -builder will.have the burden EI2CtrICai R 017{ of. proving, that he did not build or improve for the purpose of sale.) ; .- ❑ I, as owner of the property, am exclusively contracting with.licensed contractors to.con- Plumbing Z � 9; struct the project. (Sec. � 7044, Business and Professions Code: The. -Contractor's License Law A -does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with contractor(s) licensed pursuant to the Contractor's License Law.) - - O I am exempt undecSec. Grading B. & P.C. for this reason - ,Y Driveway Enc.71i_ Dateowner_ ° ` Infrastructure % _ I _ - 1 wren_ :=I- *^'gA T. = vy_irrZ 1 rv,:_9; nn WORKERS' COMPENSATION DECLARATION.' hereby affirm that I have a certificate' of conserit'to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with.the city. ❑ Certified copy is hereby furnished: . . TOTAL $3,491.•.64 CERTIFICATE OF EXEMPTION FROM REMARKS t r WORKERS'. COMPENSATION INSURANCE_ (This NSURANCE_- (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) certify that in the performance of, thg work for which this permit is issued, I shall not * �! '"°'� !. f-Nt"f t "I {:y p—•t.: );L{ „t, h 11 an '' employ. y person in any manner so as to subject to the Workers' Compensation Laws of California. Date Owner" NOTICE TO APPLICANT: If, after making this Certificate of 'Exemption you should become ZONE: BY: subject' to 'the Workers' Compensation provisions of the Labor Code, you must forthwith. Minimum Setback Distances:. ' comply with such provisions or this permit shall be deemed revoked. - - Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency'for the performance of the work for, which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building' permit when properly filled out, signed and'validated, and is'subject to ' - t 9 expirationif work thereunder is suspended for 180 days. �.% Permit I certify that I have read this application and state that the above information is correct. Issued by:, Date yt-lG agree,to comply with all city and county ordinances' and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above-. - - mentioned property for.inspection purposes. Validated by: Signature of applicant Date Mailing Address_ Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO, FT, ® CARP. S0. FT.,® WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK I ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM Q�eEMP. POLE= !i _ KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL r► ��� SO.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBLTAL TOFEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. fEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACKC,ROUND PLUMBIN� �� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS EWER OR SEPTI ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) Q�eEMP. POLE= !i _ GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. RAMING3Q FINAL INSP. ROOFING r► ��� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF NOTICE: THIS ®®CUMEINTMMO ` FEES SE ®UPLICATE®. TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado La.Quinta, CA 92253 (W �7 This is to certify that developer ofwhic is , located atwin this District, has paid school facility fees imposed pursuant to the authority generated by Government Code ectiol 53080 in t ount of y- eo ) covering a total of 0-0 sq are feet of (" 'dential or ( ) industrial/commercial development and that buil ing permits for this footage in this development may n be issued y your jurisdiction. r D SERT SANDS UNIFI SCHOOL DISTRICT White - Building Department • Yellow Facilities Planning • Pink - Accounting • Gold . Developer (10)-37 FIDELITY NATIONAL TITLE INS. CO. Est. -..No. 1180-4 . Loan:Nq. ' a J - . cc W b1 WHEN RECORDED :MAIL TO: x Don"H6ward & Emma Howard 79-811: Country Club Dr, "B" ;Bermuda Dunes, "Calif '92201 - 3 Q NO COR FRE D Yco A16 CQ N .E o �- -$ m c.D W ' F- C. - W SPACE ABOVE THIS- LINE FOR RECORDER'S USE .. before me, the undersigned, a Notary Public in and for said State, per- sonally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same. WITNESS my hand and official seal. SlgnatUre (This' area for official notarial "seal) 1002 (6/82) MAIL TAXSTA TEMENTS-AS'DIRECTED ABOVE personally appeared_.....:.... E YN GAL-NG 10 Proved tome on the basis of. satisfactory e'viderv-0 I to be the person(S)_whose name is subscribed to the within instrument, as the Attorney ---in fact : of E EDGARDD L. TIOSFCO (D. and acknowledged tome that- _subscribed the name :M of---.EDGARDD L. TI ,6 principal— . and her OSECO thereto as —own name—as Attorney in fact. Signature— --- ji9SE&GE4- ' M Xm_m, '. a M, STATE OF CALIFORNIA ar COUNTY OF RIVERSIDE S.S. On this the._ 9th day of ()Ct ig 87 before me, 40 the undersigned, a Notary Public in and for said County and State, personally appeared—EVELYN GALANG proved to me on the basis of satisfactory evidence LL 0) to be.the person(i)—whose name is subscribed to the within instrument, as the Attorney -in fact, of C EX(JPERI0 L. TIOSECO 6 C1 and acknowledged tome that-..-S--he _--subscribed the name OIEXUPERI0 L. TIOSE00 thereto as Go her ' A 16 principal—and own name—as ttomey—in fact. cc CL S,ignature d -ERST-R-OM, C? U. MIMI FOR NOTARY Sk& OR STAMP` OFF ICIAI'. SEAL % Jury u c::/ SegerStrom :.."NUTARY Pijr;LIC-CALiI`0kNIA PRINCIPAL. OFFICE IN RIVERSIDE CUUNTY MY Commission Eitpites July. 7. 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL Judy Seeerstrom Ni)[AkY FW -UC CALIFORNIA f PHINCII-Al. i;t I WCIN • RIVCRI,.'U[ WiNly My Commission Expires July 7, 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL J1,10V Segerstrom Noiwiy PUBLIC-.CALIFORNIA Ll . ALIF IA -VRI OFFICE IN ciju y RIVERSIDE my commission Expites July STATE OF CALIFOFVIA COUNTYIDE .On this. the--2th day of 'me, the undersi19 7before Publi gned Not 1c, in anq,!6r.. said. 6 Personally appeared ty.And State; _YN GALANG a: 01 ex� Proved to me on the basis Of 'satisfactory who v nce10 be se nanjo(s) is instrument,6ubsch b0dJOth8 and acknowledged that She,Within, executed the same. S ........ . STATE OF CALIFORNIA COUNTY OF RIVERSIDE 06 On this the 9 th day of __.0C t 87 before me. Mthe undersigned, a Notary Public in and for said Gou . nty I " Slate. personally appeared_.....:.... E YN GAL-NG 10 Proved tome on the basis of. satisfactory e'viderv-0 I to be the person(S)_whose name is subscribed to the within instrument, as the Attorney ---in fact : of E EDGARDD L. TIOSFCO (D. and acknowledged tome that- _subscribed the name :M of---.EDGARDD L. TI ,6 principal— . and her OSECO thereto as —own name—as Attorney in fact. Signature— --- ji9SE&GE4- ' M Xm_m, '. a M, STATE OF CALIFORNIA ar COUNTY OF RIVERSIDE S.S. On this the._ 9th day of ()Ct ig 87 before me, 40 the undersigned, a Notary Public in and for said County and State, personally appeared—EVELYN GALANG proved to me on the basis of satisfactory evidence LL 0) to be.the person(i)—whose name is subscribed to the within instrument, as the Attorney -in fact, of C EX(JPERI0 L. TIOSECO 6 C1 and acknowledged tome that-..-S--he _--subscribed the name OIEXUPERI0 L. TIOSE00 thereto as Go her ' A 16 principal—and own name—as ttomey—in fact. cc CL S,ignature d -ERST-R-OM, C? U. MIMI FOR NOTARY Sk& OR STAMP` OFF ICIAI'. SEAL % Jury u c::/ SegerStrom :.."NUTARY Pijr;LIC-CALiI`0kNIA PRINCIPAL. OFFICE IN RIVERSIDE CUUNTY MY Commission Eitpites July. 7. 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL Judy Seeerstrom Ni)[AkY FW -UC CALIFORNIA f PHINCII-Al. i;t I WCIN • RIVCRI,.'U[ WiNly My Commission Expires July 7, 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL J1,10V Segerstrom Noiwiy PUBLIC-.CALIFORNIA Ll . ALIF IA -VRI OFFICE IN ciju y RIVERSIDE my commission Expites July STATE OF CALIFORNIA COUNTY OF RIVERSIDE } S.S. On this the— 9th —day of OCt 19__J12__ before me, W the undersigned, a Notary Public in and for said County and State, personally appeared—_ EVELYN proved to me on the basis of satisfactory evidence to be the person(s)—whose name 1S' subscribed to the within instrument, as the Attorney—in fact of MARIA ELVI RA_OCAMPO and acknowledged to me that- She subscribed the name of MARIA ELVIRA OCIMPO _— thereto as - principal and her own name--as'Attorn'ey—in fact. o a Signature P"I& .-- -. DY SEGERSTROM U c STATE OF CALIFORNIA COUNTY OF_ -RIVERSIDE S.S. On this the 9th day of C)Ct 19 87 hefore me, the undersigned, a Notary Public in and for said County and State, personally appeared__ EVII'YN GALANG LL proved to me on the basis of satisfactory evidence V� to be the person(s)—whose name is subscribed to the within instrument, as the Attorney—in fact of E EDUARDO U. TIOSECO E 0 and acknowledged to me that -.--S subscribed the name EDUARDO U. TIOSECO of thereto as • principal—and HER own name—as Attorney—in fact. Signature__ ,&_ ,j� N Y SEGL°RSTROM ' M the same. FOR, NOTARY SEAL OR STAMP OFFICIAL,SEAL Judy Segerstrom NOTARY PUBLIC -CALIFORNIA• PRINCIPAL OFFICE IN ' RIVERSIDE COUNTY • My Commission Expires July 7. 1991 FOR NOTARY SEAL OR STAMP ° OFFICIAL SEAL Judy Segerstrom NOTARY PUBLIC -CALIFORNIA PRINCIPAL OFFICE IN RIVERSIDE COUNTY Mw Commission Expires July 7, 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL °o Judy Segerstrom 'NOTARY PUBLIC-CALIFORNI PRINCIPAL OFFICE. IN RIVERSIDE COUNTY *�y'Comn Expires July 7, 1991 SAFfECO SAFECO �cM • c. .. �. w . _ .: S.S.. "'.:.4•SILIE CaAA'Ot7 Cly 5th. OCt ... day of _ 19:,,.8. .-before me, the undersigned, a Notary Public in and for said.Co6nty and State, personally appeared EVELYN T.. r,ALANr._.--- Qr proved to me on the basis;of satisfactory evidence O isubscribed to be the person(s)__....whose name�T— to the within instrument, as the Attomey—in fact of E EbIlyANUEL TIOS= and acknowledged tome that She subscribed the name of_._.T1Q.5BQ0__—__ - thereto as principal and her own name_as Attomey__in fact. ar 006 _ Signature YS STATE OF CALIFORNIA COUNTY OF RIVERSIDE } S.S. On this the— 9th —day of OCt 19__J12__ before me, W the undersigned, a Notary Public in and for said County and State, personally appeared—_ EVELYN proved to me on the basis of satisfactory evidence to be the person(s)—whose name 1S' subscribed to the within instrument, as the Attorney—in fact of MARIA ELVI RA_OCAMPO and acknowledged to me that- She subscribed the name of MARIA ELVIRA OCIMPO _— thereto as - principal and her own name--as'Attorn'ey—in fact. o a Signature P"I& .-- -. DY SEGERSTROM U c STATE OF CALIFORNIA COUNTY OF_ -RIVERSIDE S.S. On this the 9th day of C)Ct 19 87 hefore me, the undersigned, a Notary Public in and for said County and State, personally appeared__ EVII'YN GALANG LL proved to me on the basis of satisfactory evidence V� to be the person(s)—whose name is subscribed to the within instrument, as the Attorney—in fact of E EDUARDO U. TIOSECO E 0 and acknowledged to me that -.--S subscribed the name EDUARDO U. TIOSECO of thereto as • principal—and HER own name—as Attorney—in fact. Signature__ ,&_ ,j� N Y SEGL°RSTROM ' M the same. FOR, NOTARY SEAL OR STAMP OFFICIAL,SEAL Judy Segerstrom NOTARY PUBLIC -CALIFORNIA• PRINCIPAL OFFICE IN ' RIVERSIDE COUNTY • My Commission Expires July 7. 1991 FOR NOTARY SEAL OR STAMP ° OFFICIAL SEAL Judy Segerstrom NOTARY PUBLIC -CALIFORNIA PRINCIPAL OFFICE IN RIVERSIDE COUNTY Mw Commission Expires July 7, 1991 FOR NOTARY SEAL OR STAMP OFFICIAL SEAL °o Judy Segerstrom 'NOTARY PUBLIC-CALIFORNI PRINCIPAL OFFICE. IN RIVERSIDE COUNTY *�y'Comn Expires July 7, 1991 SAFfECO SAFECO LECAL DESCRIPTION PARCEL 1:. . ' Lot 6 of Tract No. 3505 in recorded in Book 57, Pages the County 7 of Riverside. State of C.Alltornia, an per ;+,,P said Cuunty and 8 of maps, in the Oiice of the L,)unty ksev`Ser of PARCEL '2: Lut 7 of Tract No. 3505 in the County o,f Riverside, State of. California, as per'Map recorded in,Book 57, Pages 7 and'8.of Maps, in the Office of the County Recorder of Said Cuunty r PARCEL 3: Lut.8 of -1°ract No. 3505 in the County.of Riverside. State; of Cal:fornia, as pur Kap . recurded in Book 57, Pages 7 and 8 of I1aps, in the Office of the County .Kccurdvr of said-Cui►nty PARCEL 4: Lot 12 of Tract No. 3505 in the County of Riverside.,, State of California, as per°.`tap recorded in Book 57, Pages 7 and 8 of Maps, in the Office of the County Recorder of said County PARCEL 5:" -- Lot 13 of Tract No. 3505 in the County of'Riverside, State of -California, as per Map recorded in Book 57, Pages 7 and'8 of Maps, in the Office of the County -Recorder of said County PARCEL 6: Lot 14 of Tract No. 3505 in the County of Riverside, State of California, as per Map recorded in Book 572' Pages 7 and 8 of Maps, in the.Office of the -County Recorder of. _. said County' l PARCEL 7•: .Lo.t'15 of. Tract No. 3505 in the County of Riverside, State of California, as per Map rec)rded in Book 57, Pages 7 and 8 of Maps, in the Office of the County Recorder of sail County.' Z O_ H U W M U) Y W Q 2 W COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM — — Applicant: Submit this form with four copies of scaled plot plan (1 20 scale) drawn to County specifications required on the attached check list. . A non-refundable filing fee of $40 is require when"tff6-Qp`ph on is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Qw^ner. Agent. Contractor. Etc.),i`� Mattiinn/g Address`�. ^� /�/ / k"/,/[��,�+ City Stale ZipCode• Telephone 'Job Property Address, r e017 or ommuntty. 'Legal Description of Property. (Lot. PM. TR) - 'Assessor's Parcel No Agency o WNI � ` 7 /9 r`` �"� � e' PIa7gCase a Use of Permit) �It1+1.f'f.��n^`-' Lot Size �. t, q., (� 7 ate? r A' SFD. MH Site Preparation Etc.— X/ 1! Signature of Applicant v Dale ° 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes Elfm, 'tin, 6 WOCB Clearance required. ❑ Yes [?No,-" A v Soils feasibility report required. ❑ Yes b 4o''1 r Special feasibility boring report required. ❑ Yes ❑ No/ Ae Detailed contour plot plans required. E] Yes �D No Staff Specialist approval required. ❑ Yes ED No Lot Inspection Date Soils/boring report by 1 Project # Date Soils Map Page �� Soil Type A Approved by f 6tl�'c., Date A Type of System: V No. of Bedrooms 6pA % 2°•L Gcira�.4q�; (1) Septic Tank &V& Soil Rate Required ❑ Existing ©New ❑Additional ❑Replacement 1 AA.. Gals. - �i' (2) Leach line sq. ft. Sidewall allowance Install ` Line(5) 6 % Ft. Long, Leach be&Sq. (Bottom trench area) ft. rock/ Sq. Ft. ?_Ft. wide with min. inches Ft. of bottom per/running ft. ©*N%A rock below drain lines} area Leach lines/bed=special design for slope: Applicable (3) Pit Diameter No. Pits Pit BI �"�, Seepage Pit total depth N/A Overburden factor ❑,, y� 6' ,� Max. all able=depth d `./Hi ,r�//�i /.i.!'7"Y..�`J ,%�,�,.IJ.�� /�,./_/9i`_!/�._.? •,1�t�'K�letf `�.ci.� lam" ^":.`'��' _f ! �' s' ,t.::a'G.>0' ..,�' .sof-,.er ��!'" % � �.� ..q-t!•.'_..� � ll� ,'�',/�.a7 %`"i iic�9. .�' a',f.",l Ile - This application is pa prove�d/cleniedyfor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements 1'__­­ set forth in Section -B above. A building permit is necessary for the installation of the above -designed system. AJf iw7 (1) Septic tank and sewer lines must be 50' from any wells -) /Q �,_ ,tii�� S` e�,,, i„ �,, v 15z (2 Leach lines must be 100' min. from any wells including expansion area -?7A,*� 4� • �� (3)A Seepage pits must be 150' min. from any wells including expansion area F�- �--- - �F�� ,7 411 r o� . Signature of Health Official RECEIPT NO._ 3(i Issued by St Datey" f- ir')­ District: ❑ Riverside ® Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8187)